With nursing shortages a pressing issue throughout pockets of the country, one branch of nursing could help remedy the solution, says Marcia Faller, PhD, RN, and chief clinical officer of AMN Healthcare. Travel nurses can fill short-term needs while organizations are able to assess, stabilize, and hire permanent nurses without compromising patient care during a staffing shortage.
Faller says travel nurses can help fill the gaps while providing high-quality, reliable care. She points to a study slated for summer publication in the peer-reviewed journal, Nurse Leader, that reveals that patient outcomes for travel nurses and staff nurses are no different. In fact, the study asserts, travel nurses might help ease the staffing burdens and contribute to less error and nurse burnout. Using data sources from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) and National Database of Nursing Quality Indicators™ (NDNQI®), the study looked at a U.S. hospital to assess patient outcomes when using both core nurses and travel nurses.
According to Faller, most travel nurses work in temporary job assignments of three months at a time. After their rotation is done, they might stay for another three months, sign on for a permanent position, or move on to another assignment in a new location.
“It’s very appealing,” says Faller. It’s a quick and easy way to get a new job and gain both professional experience in a new area while also having the chance to travel. Some nurses want to shift their location for a life event—a child is getting married across the country or has a new baby, for instance. Or a nurse from a smaller community might want to gain experience in a larger academic center, Faller says. Maybe they have a list of places they want to see and travel nursing will help them do that while also working at a job they enjoy.
Travel nurses only account for two percent of all nurses, says Faller, but they offer both a distinct nursing career opportunity and a boon for organizations who need more nurses.
Different organizations find travel nurses help their staffing needs in varied ways, says Faller, and help keep the quality of care high. “Travel nurses give them the ability to fill vacancies where they are finding themselves short staffed,” Faller says.
Organizations can fill the positions while continuing to focus on recruiting. Travel nurses are also especially helpful when it comes to covering non-productive hours, says Faller. For instance, known times when nursing staff members are taking PTO, jury duty, has a leave of absence, or even needs educational time off are all good times for travel nurses to fill in. Travel nurses can also help offset overtime costs and hours. “Those have to get covered somehow,” says Faller, and helping ease up on too much staff overtime can also help offset nurse burnout and eventually retain nurses and keep turnover down.
If an organization is launching a new event, like electronic medical records, travel nurses can help cover staffing while regular staff is undergoing training.
And Faller notes that travel nurses are held to the same high standards as staff nurses. They need to have the same credentials as other nurses for whatever location they are going to, she says. And while approximately 25 states are part of the multi-state contract that allows nurses to use one license for many states, the rest of the states do require independent state licenses. Travel nurses also must pass background checks, drug screening, and any other requirements for hiring. And travel nurses are well-educated, she says, with 64 percent of travel nurses having a BSN or higher.
A nurse with a couple of travel experiences under his or her belt has some valuable skills, says Faller. These nurses are adaptive by nature, learning quickly how an operation is run and how to find what they need to do their jobs well.
As the demographics of the country continue to change and become increasingly diverse, travel nurses can help fill a gap and provide a service that many organizations need. Nurses who speak multiple languages or who fit with the cultural background of the patient population being served are especially valuable, says Faller. “There is a large demand for that cultural matching,” she says, noting that even a familiarity with a certain culture can help organizations align with their patient populations in a way that helps everyone.
Whether you are considering travel nursing for a career move or are an administrator assessing the best way to fill in the gaps, travel nursing is an option that’s both viable and valuable.
Each year, National Nurses Week brings celebrations across the United States. But within that week is an important reminder of the work that nurses do across the globe, under varying conditions, with dramatically different equipment, but with the same steely determination to protect the health of the people they care for.
This year, International Nurses’ Day is celebrated on May 12, Florence Nightingale’s birthday. Nightingale, as many know, is considered an early healthcare innovator who founded modern nursing practices and helped shape nursing to such an extent that her influence remains to this day. Nightingale’s passion for aiding the ill and injured and keeping nursing practices focused on sanitation helped saves lives of those in her care and countless lives today.
The International Council of Nurses (ICN) sponsors the day and has designated this year’s theme as “Nurses: A Voice to Lead, Achieving the Sustainable Development Goals (SDGs).” Nurses around the world can participate and unite their nursing voices by using the hashtags #VoiceToLead and #IND2017 in their social media posts.
The SDGs are a collection of more than 17 goals that impact nurses and the care they provide. The health inequities experienced by people around the world result from a mix of factors, but all impact the sustainable development issues facing nurses today. The issues range from ending poverty (that’s goal number one) to improving health and education and fighting climate change.
In honor of International Nurses’ Day, which debuted in 1965, the ICN is providing case studies from nurses across the globe—for instance there’s the story about addressing COPD in China to reducing the HIV stigma in Zambia.
For nurses who are interested in finding out more or adding their voice to the international nursing community, a Resources and Evidence toolkit is available for download.
According to the International Council of Nurses website, the organization “is a federation of more than 130 national nurses associations representing the millions of nurses worldwide. Operated by nurses and leading nursing internationally, ICN works to ensure quality care for all and sound health policies globally.”
The nursing program at MidAmerica Nazarene University, with the help of Digital Third Coast, created an infographic depicting data on the perceived stigma of male nurses. Through their research, they gleaned quite a lot of interesting information.
For example, while it’s well-known that mainly men served as nurses in the past, their research indicates that “Due to associations with the military and religious orders, there was significant male representation in the nursing profession through the late 1800s.” The visual even shows a photo of famed poet Walt Whitman with his male nurse, Fritzenger.
When did this all change? According to the graphic, legal barriers in the early 1900s contributed to the scarcity of male nurses. In fact, many nursing schools would not even admit men. This didn’t officially change, though, until 1981 when the U.S. Supreme Court ruled that not admitting men to nursing schools was unconstitutional.
As a result, during the 1930s and 1940s, the percentage of nurses who were male decreased to its lowest point, which according to the U.S. Bureau of Labor was 1%. Not surprisingly, that percentage has risen over the years. As stated in the 2013 Census, out of the 3.5 million employed nurses, 78% are Registered Nurses (9.6% of these are male); 19% are Licensed Practical and Vocational Nurses; 3% are Nurse Practitioners; and 1% are Nurse Anesthetists (41% of these are male).
From these statistics, it can be concluded that men are more likely to become nurse anesthetists—which is the highest paid role in the nursing field. With women making up the majority of the nursing field, one would assume that they tend to make more in terms of salary, right?
Wrong. Female nurses make only 91 cents per every dollar that male nurses make.
For more fascinating facts about the perceived stigma of male nurses, check out the infographic here.
As Black History Month draws to a close, now is an excellent time to reflect on all the nurses who paved the way for today’s increasingly diverse nursing workforce.
The numbers still don’t reflect the levels of diversity in the country as a whole, or even necessarily in the settings where they work, but African-American and black nurses are entering the nursing profession and earning advanced nursing degrees in greater numbers than ever before.
According to the Bureau of Labor Statistics, the nursing workforce is achieving greater diversity, but there’s still a long way to go. While the 2015 National Nursing Workforce Study stated 19.5 percent of nursing respondents reported a racial or ethnic minority background, the rate was even higher among newly registered nurses.
With a nod to early black nurses like Sojourner Truth or Harriet Tubman, who each paved the way for minority nurses to follow, nurses are expanding into many specializations and gaining higher degrees. With the current push to have 80 percent of nurses educated with a completed bachelor of science in nursing by 2020, higher ed and advanced degrees are an important part of getting ahead in nursing. Of the 176,000 nurse practitioners, 8.5 percent are African-American. And of the 3,102,000 registered nurses, 11.9 percent are African-American.
Minority nurses continue to make big strides in increasing the diversity of the overall nursing population. According to American Association of Colleges of Nursing (AACN) figures, the percentages of black or African- American nurses earning master’s or doctoral degrees has increased significantly in the past 10 years.
In 2006, 10.6 percent of those earning doctoral degrees were African American. In 2016, that percentage jumped to 16.2. And in those same years, the number of those earning master’s degrees also saw a percentage jump. In 2006, 11.3 percent of those going for a master’s degree were black. Ten years later, the percentage was 14.3. Overall, the percentage of minority nurses seeing nursing degrees hovers at about 30 percent of the total.
All that good news helps patients who say they want to see a diverse workforce in the healthcare professions. Many patients feel comfortable with someone who looks like them, but, more importantly, a diverse workforce helps spread culturally competent nursing practices. The entire nursing staff may not represent the ethnic diversity in a given setting, but they can learn from those who might understand certain cultural traditions, languages, or practices. All that understanding makes for better patient care and outcomes and an especially effective nursing staff.
So as Black History Month draws to a close, take a few moments to reflect on how far African-American and black nurses have come and the essential care and understanding they provide to the public. And take a moment to take pride in being part of that.
During this year’s CRNA Week (#crnaweek), there are many nurse anesthetists who are remembering why they got into the profession, and even more are reflecting on how the face of the profession is changing.
John Bing, BSN, CRNA, American Association of Nurse Anesthetists (AANA) Region 6 director, and national AANA board of directors member, says one of his steadfast missions is to make sure the field continues to attract top nurses, but that it is especially welcoming to aspiring minority nurse anesthetists.
Bing knows first-hand how hard it is being a minority in the field. When he first started out, he was often the only African American in the OR, he says. At times, people assumed he was part of the housekeeping staff. Although he laughs about it now, Bing has made it a direct part of his mission to attract more minorities into this field.
He even takes on leadership positions with the primary goal of making sure he is representing the minorities in the field. “You need to see that in leadership,” he says. “If others don’t see that, they won’t see a place for them. I make sure they see it.”
“Many times you would go in and you were it,” he says of when he started out. “Maybe you were the only one in the hospital or the department. Now you go in and you see a fair amount [of minorities].”
As a president of the Diversity in Nurse Anesthesia Mentoring Program, Bing also makes sure his students know why he enjoys this profession so much.
One of Bing’s specific approaches is to make sure he talks to patients as the anesthesia takes effect. He finds out what they like so they can chat about it—sports, cooking, books, kids—anything that helps them relax. “That’s like a sedative,” he says. “It calms them down and they remember that.”
And while he’s monitoring a patient, Bing does exactly what he teaches his students—he assesses his patient over and over and over. “You must rely on your instinct,” he says. During travels with students to countries like Nicaragua, Bing teaches students that not every machine is calibrated the same or even correctly.
“The machine is a guideline,” he says. “You are ultimately responsible for anything that happens. You can’t blame the machine for anything. Look at the patient.”
Bing says that while he’s checking blood pressure every five minutes or so, he is constantly “circling the block,” as he calls it. All the machines are incredibly helpful, but they should only confirm what a nurse anesthetist is seeing, hearing, smelling, and touching.
And getting stale in this profession is not an option, he says. “I say to my students, ‘Tell me how this patient could die today,’” he says. That forces students to look at the big picture and not just look for complications, but to look for other factors that could impact that patient on that day.
Bing clearly enjoys working with his students, but he understands first-hand how sometimes they are not the ones who chose the profession. “The last thing I thought I would be was a nurse,” he says with a laugh. As an African-American, there were few role models that looked like him.
A chance look at a jobs list that revealed six pages of nursing jobs, convinced Bing, an athlete in high school and college, to take a look. Bing says he turned to his buddy he was working out with and said, “We get to be around girls and have a great job!” But he still didn’t expect to land in this field. Eventually, nurses in the recovery room where he worked nudged him to give it a try.
Now, Bing’s mission is to attract minorities into nurse anesthesiology. He speaks to kids in schools, paying special attention to making the field appealing to boys and young men. As it is, 49 percent of nurse anesthetists are male, he says, which is a high number considering less than 10 percent of all nurses are male.
But Bing lets kids know that there are chances to be out on a helicopter go team or even in the midst of trauma situations. “Men like that kind of stuff,” he says and it certainly gets the attention of younger kids who don’t know those possibilities exist.
Add in the good salary, the camaraderie, and the fair amount of autonomy, says Bing, and a career as a CRNA shows kids who might not initially consider a nursing career that the path is open to more possibilities than they ever imagined.
What is diversity? According to the Oxford English Dictionary, it is “the condition of being diverse, different, or varied; difference, unlikeness.” This simplistic definition of diversity does not assign any judgment or negative connotation to any of the words used to define it. However, the word “diversity” evokes multidimensional judgements, reactions, ideas, emotions, and actions, some of which could have adverse social and health consequences for generations of individuals in the United States.
Nursing, as the largest health care workforce in the United States with over 3 million nurses, is well positioned to champion diversity efforts. In 2010, the Institute of Medicine (IOM) published a landmark report, The Future of Nursing: Leading Change, Advancing Health. In this report, the IOM indicated that the nursing profession was not diverse to care for diverse populations across the lifespan. The IOM recommended that a diversity agenda be promoted, especially with increasing the diversity of nursing students. In partnership with AARP, the Robert Wood Johnson Foundation (RWJF) launched a campaign to implement the IOM recommendations from its 2010 report. Subsequently, commissioned by the RWJF, the IOM evaluated the state of affairs regarding these recommendations. In 2015, another report, Assessing Progress on the Institute of Medicine Report The Future of Nursing, was published. In this report, the IOM specified that nursing has improved on the recommendation to diverse the nursing workforce. Nonetheless, there remain gaps that must be addressed to meet the diversity goal for the nursing profession. Consequently, the new recommendation for nursing is that diversity must continue to be a priority that is paralleled with a series of actions to promote it. Before nursing can accomplish this noble goal, there should be a well-vetted strategic plan on diversity and inclusion in all nursing programs, schools, and colleges in the United States. Students, faculty, and staff must be an integral part of the dialogue to promote diversity within the nursing profession.
At the University of Florida College of Nursing (CON), we held our inaugural “Diversity and Inclusive Excellence” workshop in December 2015. This two-day workshop was designed for staff and faculty. As a member of the Diversity taskforce, I collaborated with the other taskforce members to invite G. Rumay Alexander, EdD, RN, FAAN, to lead the CON on this discussion. Alexander is director of the Office of Inclusive Excellence in the School of Nursing at the University of North Carolina at Chapel Hill, a nationally known expert with vast knowledge and expertise on diversity and inclusive excellence, and president-elect of the National League for Nursing.
During the early morning hours of December 3, 2015, my individual lesson on the topic began with Alexander as I had breakfast with her. My antenna on the topic sharpened following our conversation. After introducing her to my fellow Diversity Taskforce members, I hurried to pack my car and return to the CON to proceed with the plans of the day. I noticed the dean, Anna McDaniel, PhD, RN, FAAN, from a distance. I hurried up to keep her pace. “Good morning, Dean,” I greeted in my usual manner. McDaniel responded with a broad smile and a twinkle in her eyes that I perfectly understood. I surmised that McDaniel had finally accepted the fact that I love referring to her as the “Dean.” We conversed as we headed to the CON and into the elevator. I noticed the necklace McDaniel wore. The costume necklace had different shapes, colors, sizes, lengths, and mosaic designs. They were
- audaciously woven, yet unintimidating;
- different, yet complementary;
- individually, unassuming — yet, together, a paragon of beauty, inviting;
- all held by a perfectly thin strand, yet unbreakable.
“That’s a beautiful necklace,” I uttered. “It belonged to my mother, who died twelve years ago,” McDaniel shared. “Each bead came from a different country. I have a brochure that provides a description of each bead, including the country of origin and its material composition.” Then, McDaniel voiced the word that gladdened my heart. “I wore this necklace today because it’s appropriate to celebrate diversity, the topic of the CON workshop.”
McDaniel had appointed the Diversity Taskforce and provided us with her full support. But, the fact that she actually thought of and adorned herself with a necklace that I now coined as a “diversity necklace” to celebrate the CON inaugural diversity workshop was admirable to me.
Someone not sensitive to the current diversity concerns around the United States, and the racial unrest related to such matters, may not appreciate my exhilaration upon hearing the history of the necklace. At issue is that, in several communities around the United States, numerous individuals are thoughtless about the devastating effects of antidiversity rhetorics and actions on the lives of its victims. Many may not realize that any action, whether good or evil, begins in the mind. Conversely, any work to combat uncelebrated diversity and exclusivity must begin in the mind. When people think about and proactively perform small acts, such as expressing recognition of diversity through a piece of jewelry or other special actions to celebrate diversity, it goes a long way. It could change the thought process from exclusion to inclusion. When people are attentive to their behaviors and understand the detrimental effects their actions could have on other human beings, things might change for the better. I believe that, as a nation, we must check the poisonous thoughts that percolate in our minds and subsequently manifest in forms of antidiversity rhetorics and behaviors, unacceptance, and racism. Confronting monstrous suggestions in the mind is the first step that many of us need to take to begin to challenge the subtle and insidious systemic diversity-aversion and exclusion in the United States.
As I thought about this issue of diversity and the role that nursing can play to eliminate it, I reminisced about how the imperfections of people categorized within the social construction of race stimulate antidiversity and anti-inclusive sentiments and movements. I wondered how nursing can care for these individuals, many of whom are marred with scars of history. My poem, “The Color of Justice,” captures my perceptions of the undeniable genesis of these historical blemishes that shockingly remain, overtly or covertly, as status quo in various parts of this country.
The Color of Justice
What color is justice?
Absorbing pain, insults, and lashes
Ancestors packed shoulder-to-shoulder, hip-to-hip,
chained like fire woods
Bones of the feeble lie un-mourned in ocean deep
across the Atlantic
Their sweat built the wealth in the new world, but
crumps have become their portions
This name sound like them, we have filled the position,
they need to go away
Low-hanging pants, cove-hopping birds,
We cannot deal with the anger, we are better off
with the accent, intra-color battle ignited
Round them up, throw away the key, population control
Babes on the breast, mama and grandmamma, sitting
on the front porch pondering about the next check
Hair tightly woven, fried, or twisted, nails freshly manicured, next bun in the oven
The fortunate may triumph at the end, treacherous roads treaded, stress claims the wounded body after all
That they survive is still a mystery that ought to win
them a trophy
Who are they?
What color is justice?
Reflecting heat, demanding respect, crushing heads
Rolled into the new world in Mayflower boasting of
prostitutes, thieves, and prodigal sons
Raised arms against raised tea taxes, won freedom
but deny it to another
Melanin deficient hue suggest superiority
Blood by blood, noose on hand, destroyed a generation,
Deeds done in the name of God, He must be weeping
Damages proudly scattered in museums, we pay to
relive the tragedy
Privileges left and right on the backs of the poor
Man in bow tie, lady in heels, rear the children, your lavatory in the rear
Own your history, mend your ways, teach your babes right
Who are they?
What color is justice?
Broad face, warm hue, and welcoming gesture
Land is supreme and cares for the offspring
Infected with strange diseases, killed with gun powder, survivors kept in special places devoid of opportunities
Culture deconstructed, the sacred used as mascots
Surviving by balancing mind, body, and spirit, harmony
in the land is their mantra
Not many left but their spirit is strong
The land beckons for their touch, to purge its roots of deadened souls
What does the Unites States’ constitution say about them?
Who are they?
What color is justice?
Messiah has come, awaiting messiah, there is no messiah
We profess peace, spiritual path is the way
Whose belief is superior?
When six feet under, belief quenches, but tainted
souls still suffer
Where are their senses?
Who are they?
What color is justice?
Light? Energy? God?
Penetrates Black, White, Red hue, religious, non-religious
Building block of things created
Revitalizes without questioning, unites all things created
Shines for Black, White, and Red hue, religious and
Knows no foolishness but shines for fools
Knows no discrimination but supports the life of discriminators
Invites reconciliation until judgement day
Come unto me Black, White, and Red hue, religious,
My light is your strength, unity, and peace
One may wonder how a nurse who is an advocate for a diverse, inclusive, and just world could pen “The Color of Justice.” This poem reflects my dual perceptions as a black woman and a nurse, of how the historical racial unrest that has plagued the United States for centuries has been subtly perpetuated even today. But, they ought not have continued, had the United States paid real attention and reconciled both the apparent and undercurrent narratives of this poem after the abolition of Jim Crow laws. As a black woman, I think that the first relevant question ought to be: How do individuals from diverse backgrounds interpret their historical or lived experiences in the United States? I encourage each one of us to answer this question individually or as a family, church, academic institution, or financial organization. I assert that there must be a recognition and acceptance of the different dimensions of diversity of thoughts, ideas, and experiences. This recognition must be matched with “courageous dialogue” on diversity and inclusion. In addition, there have to be concrete and measurable action plans for allocating resources to implement iterative strategies to address identified diversity concerns. This exercise could be so powerful that diversity and inclusion become strengths and not detriments to our collective humanity.
As a nurse, I think the second pertinent question must be: What role can nursing play to mitigate the adverse generational effects of antidiversity and anti-inclusivity experiences on marginalized and excluded individuals? I contend that, in order for nursing to be professionally and culturally relevant in the future and to continue to have the public trust as a caring discipline, we must identify ways to champion the diversity and inclusive excellence agenda. There should be constant and mandated training on diversity for university staff and faculty, with measurable outcomes. Nursing as a profession should develop a curriculum with a diversity and inclusion plan threaded throughout it. One approach to operationalize this suggestion is to equip nursing students with skills necessary to be culturally competent, diversity-savvy, and inclusive-perceptive in order to encourage these values in their work settings. Patients and clients at the receiving end of compassionate, culturally competent care infused with the spirit of diversity and inclusiveness should remember the feelings associated with that care, and hopefully pay it forward. Slowly, the culture of superiority and nontolerance directed toward individuals from diverse backgrounds could dissipate and a new world facilitated by nursing and inhabited by truly compassionate and empathetic humans would emerge.
Nursing students are the future of the nursing profession. Therefore, nursing must constantly remind students that antidiversity and anti-inclusion rhetorics and behaviors, historically and contemporary, breed racism in the United States. They should also learn to celebrate how much improvement we have made as a profession. But, recognize that diversity work is lifelong. The juxtaposition of the history of racism in the United States with the improvements made toward eliminating it is useful for at least two reasons: The contrast provides the space for constructive discourses and opportunities to develop positive avenues for endorsing diversity, and it allows for future and ongoing actions to completely obliterate racism heralded by antidiversity and anti-inclusive beliefs in the United States. Consequently, bead by bead—though diverse in shapes, colors, sizes, lengths, mosaic designs, and historical origins—we can hang unbreakably strong on the perfect strand of humanity, which unites us as “one Nation under God.”